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Antibiotic No Better For Coughs, Uncomplicated Chest Infections Than No Medication

Amoxicillin, the antibiotic doctors often prescribe for persistent coughs caused by uncomplicated chest infections such as bronchitis, is no more
effective at easing symptoms than no medication at all, even in older patients. This was the finding of the largest randomised placebo controlled trial of
antibiotics for lower respiratory tract infections (LRTI) done to date.

The study, which was led by the University of Southampton in the UK, is from the GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium and was funded by the European Community's Sixth Framework Programme.

A paper on the findings appears in the 19 December online issue of The Lancet Infectious Diseases.

First author Paul Little, Professor of Primary Care Research at Southampton, says in a statement:

"Patients given amoxicillin don't recover much quicker or have significantly fewer symptoms."

In fact, he adds, using amoxicillin to treat patients with respiratory infections who don't have pneumonia could not only be ineffective, but might actually harm
them.

"Overuse of antibiotics, which is dominated by primary care prescribing, particularly when they are ineffective, can lead to side effects such as diarrhea, rash,
vomiting and the development of resistance," he explains.

Chest infections, also known as lower respiratory tract infections (LRTI), are one of the most common acute illnesses treated in primary care settings in
developed countries.

There is a lot of controversy about whether LRTI, especially in older people, should be treated with antibiotics, especially since viruses are thought to cause most
of them, and previous studies have shown inconsistent results.

The participants were randomly assigned to be prescribed either amoxicillin or a placebo, to be taken three times a day for seven days.

The prescribing general practitioners (GPs) assessed their patients' symptoms at the start of the study period, and the patients also filled in diaries of their daily
symptoms.

When they analyzed this data, the researchers found there was little difference in how severe the symptoms were or how long they lasted for, between the
amoxicillin and placebo groups.

Even in those aged 60 and over with no other illnesses, antibiotics seemed to offer little benefit over placebo.

Patients in the antibiotic group reported significantly more side effects, including rash, nausea and diarrhea.

The researchers did conclude, however, that while most people seem to get better on their own, there is a small number of patients who do benefit from
antibiotics, and "the challenge remains to identify these individuals," says Little.

In an accompanying commentary, Philipp Schuetz, from the University of Basel in Switzerland, notes:

"Little and colleagues have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in
whom pneumonia is not suspected."

However, the question remains, he says, of whether this "one-size-fits-all approach can be further improved".

He suggests perhaps one way to avoid the "toxic effects and costs" of antibiotics and "the development of resistance in the other patients", is to test for "specific
blood biomarkers of bacterial infection", so as to "identify the few individuals who will benefit from antibiotics despite the apparent absence of
pneumonia".

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